Close

Majors

Winds and Percussion Form

  • Winds and Percussion Camp Form

     
     
    Registration and Medical Information
    Please complete the registration no later than May 22. If completed by May 22, the fee is refundable less a $50 administrative fee. For more information, contact James Swearingen at jswearin@capital.edu or Megan Hennes at mhennes@capital.edu. Information and maps will be sent the week of May 22, 2017.  
     
    First Name
     
     
    Last Name

    Middle Initial
      
     
    Gender  
              
     
    Address

    City
     
    State


    Home Phone
     

    Emergency Phone #1
     

    Emergency Phone #2
     
     
    Parent's Email (for camp reminders, updates and materials)

    Grade (Fall of 2017)


    Instrument (for baritones, please indicate bass or treble clef)
      
     
    Current Director's Name 
      
     
    Current Director's preferred Email Address*
        
     
    School (current)

    School Address
     

    City


    State  

    Zip Code


    Shirt Size (adult sizes)

       
    Years of participation
                                                          

    Important Medical Information

    Name(s) of Parent(s) / Guardian(s)

    Name of Physician
     
     
    Physician Phone


    Date of Last Tetanus Shot 
     


    If participant has a physical or other condition that may pose an undue risk to the participant or others in the program, please provide necessary information or special requirements (e.g., medications) or requested accommodations. 
     
     
     I hearby give permission for emergency medical treatment of the child named above by his/her own physician or a physician on-call. 

     I authorize my child to participate in all activities of the Capital University Winds and Percussion Camp, June 5-9, 2017. I understand he/she is expected to observe all camp rule and in case of failure to do so, I am responsible for immediate transportation home. I further understand and agree  that there will be no refund of camp fees in the event of my child's dismissal from any portion of the camp.
     

    By submitting this form, you agree that all information contained within is correct and that you are the legal guardian of the participant as stated in this form.
      

    Please do not attempt to submit more than once. The form may take several seconds to process.